Abstract

BACKGROUND AND AIMS: Prescription opioid injection (POI) is a leading risk factor for hepatitis C virus (HCV). Residential context relates to high-risk injection behavior. This study assessed whether residence in the inner city (vs. surrounding areas in Montreal Island) modified the effects of correlates of POI or the relationship between POI and HCV incidence. DESIGN: Prospective cohort study. SETTING: Montreal, Canada PARTICIPANTS: 854 people who inject drugs (18% female, 25% age < 30) living on Montreal Island, were interviewed every 3-6 months from 2004-2012. MEASUREMENTS: Study visits included HCV antibody testing and an interviewer-administered questionnaire. Generalized estimating equations were used to test whether place of residence modified the effects of correlates of POI. Cox regression was used test whether place of residence modified the relationship between POI and HCV incidence. FINDINGS: At baseline, inner-city participants were more likely to report POI in the past month (40% vs 25%, p < 0.001). The association between POI and heroin injection, syringe sharing and sharing of injecting equipment varied according to place of residence and was greater in the inner city. The hazard of HCV infection associated with POI was greater among inner-city participants compared to those in the surrounding areas (adjusted HR: 3.19, 95%CI: 1.85-5.51 vs HR: 1.26, 95%CI: 0.65-2.42, p = 0.025). CONCLUSIONS: Among people who inject prescription opioids in Montreal, Canada, those who live in inner-city areas are more likely to engage in injecting-related risk behaviors and have a higher risk of hepatitis C virus infection than those who live in the suburbs.

This work was supported by the Canadian Institutes of Health Research (CIHR) [MOP135260; MOP210232] and additional support from the Réseau SIDA et Maladies Infectieuses du Fonds de la Recherche en Santé du Québec [FRSQ5227]. RSD was supported by an NHMRC Early Career Fellowship and MH was supported by an NHMRC Senior Principal Research Fellowship. DJA holds a Clinical Researcher Career Award from the Fonds de la Recherche en Santé du Québec. YK holds a CIHR applied public health Chair in Urban Interventions and Population Health. The Burnet Institute is supported by the Victorian Operational Infrastructure Support program.

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This work was supported by the Canadian Institutes of Health Research (CIHR) [MOP135260; MOP210232] and additional support from the Réseau SIDA et Maladies Infectieuses du Fonds de la Recherche en Santé du Québec [FRSQ5227]. RSD was supported by an NHMRC Early Career Fellowship and MH was supported by an NHMRC Senior Principal Research Fellowship. DJA holds a Clinical Researcher Career Award from the Fonds de la Recherche en Santé du Québec. YK holds a CIHR applied public health Chair in Urban Interventions and Population Health. The Burnet Institute is supported by the Victorian Operational Infrastructure Support program.